Electrochemical determination of factor XA inhibitors

ABSTRACT

Methods and devices for determining factor Xa inhibitors, in particular heparins and fractionated or low-molecular-weight heparins, as well as direct factor Xa inhibitors in blood samples. The methods include contacting a blood sample with a detection reagent that contains at least one thrombin substrate having a peptide residue that can be cleaved by thrombin and is amidically bound via the carboxyl end to an electrogenic substance, and with a known amount of factor X reagent and an activator reagent which induces the conversion of factor X into factor Xa. Subsequently, in a second step, the amount or activity of the electrogenic substance that is cleaved from the thrombin substrate by the factor Xa-mediated thrombin activation and/or the time course thereof is determined as the measurement signal using electrochemical methods. In a third step, the amount of the factor Xa inhibitor in the sample of the blood to be analyzed or a measured quantity that correlates therewith, in particular a clotting time that correlates therewith, is determined on the basis of this measurement signal.

CROSS REFERENCE TO RELATED APPLICATION

This is a continuation of International Application PCT/EP2007/009347,which has an international filing date of Oct. 7, 2007.PCT/EP2007/009347 claims the benefit of European Patent Application No.EP06123234.4, filed Oct. 31, 2006. PCT/EP2007/009347 is incorporated byreference herein.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The invention concerns methods for the electrochemical determination offactor Xa inhibitors, especially of heparins and heparin derivatives aswell as direct factor Xa inhibitors in blood samples.

In addition the invention concerns test elements based on dry chemistryand test element analytical systems for the electrochemicaldetermination of factor Xa inhibitors, especially of heparins andheparin derivatives as well as direct factor Xa inhibitors in bloodsamples.

2. Description of Related Art

Anticoagulants which in particular also include heparins are often usedin clinical practice for the prophylaxis and therapy of haemostaticdisorders (disorders of the coagulation system). Heparins and heparinderivatives are used especially for the therapy and prophylaxis ofthromboembolic diseases. They are very effective in the prophylaxis andtreatment of leg vein thromboses, pulmonary embolisms and for treatingunstable angina pectoris and acute myocardial infarction. They are alsooften used during operations and in particular for cardiologicalprocedures (bypass) and for blood transfusions.

The action of heparins is mainly based on their interaction withantithrombin III (ATIII) as a result of which they change theconformation of ATIII. This accelerates the inactivation of certaincoagulation enzymes (thrombin (FIIa), factor Xa (FXa) and factor IXa)and thus coagulation is prolongated. Heparins can thus be classed asfactor Xa inhibitors. Other factor Xa inhibitors are for example certainoligo-saccharides such as the pentasaccharide Fondaparinux orlow-molecular-weight direct factor Xa inhibitors which are still inclinical development and can be assigned to different classes ofsubstance. In addition to unfractionated heparins (UFH) which have beenused for a long time, various fractionated heparins orlow-molecular-weight heparins (LMWH) have been used since the end of the1980s. Fractionated heparins have now replaced the UFHs for manyindications and are prepared from unfractionated heparins by chemical orenzymatic depolymerization to form fragments which have only about ⅓ ofthe size of the standard heparin. This weakens among others the effectof these LMWHs on thrombin whereas factor Xa is preferentiallyinactivated. Fractionated heparins have other advantages overconventional unfractionated heparins as a result of their moreadvantageous pharmacokinetics. A review of these classes of substancewith regard to their clinical action and significance may be found in“Heparin and Low-Molecular-Weight Heparin” (Mechanisms of Action,Pharmakokinetics, Dosing, Monitoring, Efficacy and Safety), Hirsh etal.; Chest 2001; 119:64p-94p.

Patients which have been administered unfractionated heparin arerequired to be monitored due to the individual variability of thebioavailability, the protein binding and short half-life of 30-150minutes in order to avoid a possible overdose with an increased bleedingtendency or an underdose with an increased risk of thrombosis. In theclinical routine treatment with UFH this is most frequently monitoredusing the activated partial thromboplastin time (aPTT) and also by thethrombin clotting time (TCT) or activated clotting time (ACT). Theseassays are so-called global assays because they unspecifically reflectthe thrombin-induced formation of a fibrin clot. The aPTT test whichprimarily determines the activity of the factors of the intrinsicsystem, is mainly sensitive to the inhibitory effects of heparin onthrombin. The aPTT test is sensitive for the heparin range of 0.1-0.7U/ml but the normal range of aPTT as well as its therapeutic rangedepend very strongly on the reagent and the analyzer that is used.Another limiting factor is sample stability which often results infalsified results particularly after the blood sample has stood for toolong. Further disadvantages of such global coagulation assays are amongothers the often complex experimental procedure which requires speciallytrained personnel to achieve reproducible results and the relativelyhigh reagent consumption of these tests.

Monitoring is not absolutely necessary for normal patients whenadministering low-molecular-weight heparins due to their improvedpharmacokinetics. However, it is recommended that the therapy is checkedat the start of treatment and it is necessary especially in the case ofpatients with renal insufficiency due to their changed renal excretionand is recommended for patients with an extreme body weight, newborns,children and pregnant women or when they are used for several weeks orafter fresh traumas or operations.

In clinical routine aPTT is used above all to monitor LMWH although thistest has an only inadequate sensitivity for this anticoagulant and ismoreover dependent to a very strong degree on the detection reagent thatis used.

An FXa test is a suitable detection test for monitoring the effect oflow-molecular-weight heparins.

Previous FXa tests are usually carried out as chromogenic tests or asclotting tests where the chromogenic tests measure factor Xa activityand the clotting test measures coagulation. Both test principles followthe same test procedure:

-   -   1. FXa+[heparin/antithrombin        III]→[FXa/heparin/ATIII]complex+remaining FXa    -   2. a) remaining FXa cleaves a chromogenic residue from a        FXa-specific substrate (chromogenic test)        -   b) remaining FXa cleaves prothrombin to form thrombin            (coagulation test via thrombin-induced fibrin cross-linking)

When the sample is added, factor Xa which is present in a defined amountin the test reagent binds with the heparin and antithrombin IIIcontained in the sample and forms an inactivated complex with them. Theremaining factor Xa cleaves either the chromogenic substrate or formsthrombin with the other coagulation factors contained in the sample andthe thrombin cleaves fibrinogen to form fibrin (clot formation). More orless substrate is cleaved depending on the activity of factor Xa. Theactivity of factor Xa in turn depends on the amount of heparin containedin the sample. Whereas the chromogenic tests are specific for the FXaactivity in the sample, coagulation tests do not exclusively measure theFXa activity but are nevertheless often more sensitive for LMWH thanaPTT.

Several chromogenic tests but only a few coagulation tests (Heptest fromthe Sigma Company, ENOX test from the Pharmanetics Company) arecommercially available. The various tests correlate only moderately withone another and with aPTT because they have different end points. Thechromogenic tests yield activities but not clotting times. However,there is only a moderate correlation between the clotting time andfactor Xa activity. Furthermore, these chromogenic tests require aseparation of the plasma and they cannot be used directly in whole bloodsamples. As a result of the complicated sample preparation and processsteps and the required devices, these methods of determination aretime-consuming, labour intensive and require complicated apparatuses.Although the Heptest yields a clotting time as a result, it can,however, be very different depending on the different heparinsensitivity of the patient at the same heparin concentration.Furthermore, it is necessary to establish a heparin calibration curvefrom which the test result can then be read. Up to now only a singlefactor Xa test has been available as a dry chemistry test and thus alsosuitable for point-of-care instruments (ENOX test from the PharmaneticsCo.) which is carried out using a test card on the Rapid Point analyzerfrom Bayer AG. This test was specially developed for the use ofEnoxaparin for percutaneous transluminal angioplasty and onlydistinguishes between Enoxaparin concentrations of >1 U/ml and <1 U/mland is thus unsuitable for the routine monitoring oflow-molecular-weight heparins especially because other fractionatedheparins and unfractionated heparin interfere with the test.

WO 03/050298 describes the principle of this dry chemistry FXa test asfollows: The sample to be examined which is preferably citrated wholeblood, is admixed with a dry chemistry reagent which contains at least afactor Xa activator, preferably Russels viper venom and homogeneouslydispersed magnetic particles. Factor X contained in the sample isconverted into factor Xa by the factor Xa activator contained in thereagent and the factor Xa in turn results in the conversion offibrinogen into fibrin via the prothrombin-thrombin conversion and thusthe formation of the coagulation clot. This clot is detected by means ofoptical methods by observing the mobility of the magnetic particles inthe reaction mixture which is caused by an external oscillating magneticfield. Hence this test principle is based on the formation of a fibrinclot which is only formed during the course of the detection reaction ina multistage reaction cascade triggered by factor Xa which involvesfurther enzymes and cofactors in addition to factor Xa. Thus, forexample the polymerization and cross-linking of fibrin requires thepresence of calcium ions and activated factor XIIIa which is in turnformed from inactive factor XIII by a thrombin-dependent activation.Hence, the determination of factor Xa by means of the determination of afibrin clot is also dependent on other essential factors and possibleinterfering effects. In addition to this indirect method ofdetermination, the detection method described in WO 03/050298 requires acomplex detection and evaluation system for the factor Xa determination.Thus, on the one hand, the test carrier on which the coagulationreaction takes place must have special devices which ensure a good andhomogeneous mixing of the reagents and magnetic particles with thesample and, on the other hand, the evaluation system for determining thefactor Xa activity must have devices for generating an oscillatingmagnetic field for example by means of a movable permanent magnet andoptical systems for illuminating and photometrically detecting themovement of the magnetic particles.

WO 01/63271 (US2003/0164113) describes in general electrochemicalsensors based on dry chemistry for determining blood coagulation orindividual coagulation factors which have at least two electrodes on aninert carrier, as well as a dry reagent which contains a proteasesubstrate which consists of a peptide residue that can be cleaved by aprotease of the blood coagulation system and is amidically bound via itscarboxyl end to substituted amines and in particular to aphenylenediamine residue. After the protease-induced cleavage, thesesubstituted amines act as electron carriers of the 2nd type and can beused for the electrochemical determination of the protease activity. Inaddition to the so-called global tests such as aPTT, PT or ACT in whichthe clotting time is determined via the activity of the proteasethrombin, WO 01/63271 (US2003/0164113) also describes tests that can beused to determine individual coagulation factors or their inhibitors. Inthis case WO 91/63271 teaches the use of substrates especially designedfor the coagulation factor to be determined, the peptide part of whichis specially adapted to the protease to be determined such that it canbe specifically cleaved by this protease and the substituted amine as anelectrochemically detectable particle specifically reflects the activityof this protease. When applied to a factor Xa test this would mean usinga protease substrate which consists of a peptide residue that can becleaved by factor Xa whose carboxyl end is amidically bound tosubstituted amines and especially to a phenylenediamine residue. To thisextent the test principle is similar to that of chromogenic factor Xatests in which an enzymatic cleavage product of a factor Xa-specificsubstrate is also used to determine factor Xa.

Accordingly, the inventors have identified a need in the art to providemethods for determining factor Xa inhibitors in blood samples which canbe carried out simply even by persons that are not specially trainedwith low requirements with regard to time, apparatus or labor and whichlead to reliable results in a short time. In particular, what is neededis a method for determining factor Xa inhibitors in blood samples whichcan be simply carried out and managed with the smallest possible numberof process steps and required reagents and/or apparatuses thus enablinga rapid decentral analysis for example directly in intensive care unitsor hospital wards. It is desirable that the methods and devices fordetermining factor Xa inhibitors in blood samples also enable adetermination directly in whole blood and thus do not require anycomplicated sample preparation steps. The methods and devices fordetermining factor Xa inhibitors in blood samples could satisfy therequirements for shelf-life and stability of reagents and enable adetermination which is as accurate and specific as possible. Inparticular, a need exists for the above methods and devices fordetermining heparins, in particular fractionated heparins orlow-molecular-weight heparins as well as direct factor Xa inhibitors inblood samples.

SUMMARY OF THE INVENTION

In one aspect, the invention is directed to a method for determining afactor Xa inhibitor in a blood sample. The method includes contacting ablood sample with a known amount of factor X reagent, an activatorreagent that induces the conversion of factor X into factor Xa, and adetection reagent including a peptidic thrombin substrate that can becleaved by thrombin and having a carboxyl end that is amidically boundto an electrogenic substance. The method further includes measuring theamount or activity of the electrogenic substance that is cleaved fromthe thrombin substrate by measuring an electrochemical signal associatedwith the amount or activity of the electrogenic substance, anddetermining the amount of the factor Xa inhibitor in the sample byrelating the amount or activity of the electrogenic substance to theamount of Xa inhibitor in the sample.

In various aspects of the invention, the factor X reagent is added tothe sample spatially separated from or at a separate time from theaddition of the activator reagent to the sample. Also, the factor Xreagent and activator reagent may be present together in a dry state andfactor X is not converted into factor Xa until contact with the sample.

Another aspect of the invention is directed to a test element fordetermining a factor Xa inhibitor, the element having an inert carrierhaving at least two electrodes, a detection reagent that contains atleast one peptidic thrombin substrate that can be cleaved by thrombinand having a carboxyl end that is amidically bound to an electrogenicsubstance, a factor X reagent and an activator reagent for convertingfactor X into factor Xa.

In various aspects of the invention, the activator reagent is present onthe test element at least partially spatially separated from the factorX reagent. Also, the activator reagent may be arranged at leastpartially in front of the factor X reagent in a flow direction of thesample.

In a further aspect, the invention is directed to an electrochemicaltest element analytical system having at least one device for measuringcurrent or voltage and a test element as summarized above.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 shows an example of the primary measured result of anelectrochemical factor Xa inhibitor determination corresponding to themethods according to the invention.

FIG. 2 shows the results of electrochemical thrombin determinations withdifferent arrangements of reagent lines of an activator reagent and adetection reagent/factor X reagent combination on a test element.

DETAILED DESCRIPTION

The present invention provides methods, electrochemical test elementsand test element analytical systems for determining factor Xa inhibitorsin blood samples. More particularly, the present invention describesmethods for determining factor Xa inhibitors in blood samples which arecharacterized in that in a first step a sample of the blood to beanalyzed is brought into contact with a detection reagent which containsat least one thrombin substrate which consists of a peptide residue thatcan be cleaved by thrombin and which is amidically bound via thecarboxyl end to an electrogenic substance, and with a known amount offactor Xa, subsequently in a second step the amount or activity of theelectrogenic substance which is cleaved from the thrombin substrate bythe factor Xa-mediated thrombin activation and/or its time course isdetermined as the measurement signal using electrochemical methods, andfinally in a third step the amount of the factor Xa inhibitor in thesample of the blood to be analyzed or a measured quantity thatcorrelates therewith, in particular a clotting time that correlatestherewith, is determined on the basis of this measurement signal.

According to the invention the known amount of factor Xa is not addeddirectly as a factor Xa reagent in the first step of the method butrather takes place by adding a known amount of factor X reagent and anactivator reagent to the sample which results in the conversion offactor X into factor Xa.

The method according to the invention is further elucidated on the basisof an illustrative example:

The test principle is based on the determination of the enzymaticactivity of thrombin formed as a result of the factor Xa-inducedcoagulation reaction by means of an electrochemical measurement in whichat least one cleavage product is determined electrochemically on theelectrodes. A tripeptide substrate such as for example reduced ChromozymTH (tosyl-glycy-prolyl-arginine-4-nitroanilide acetate) which hasamidically bound an electrogenic substance via the carboxyl end of thetripeptide moiety can be used in particular as a thrombin-specificsubstrate. Such electrogenic substances are described for example in WO01/63271 (US2003/0164113) and can in particular be substituted anilines,especially nitroaniline derivatives or phenylene-diamines. The detectionreaction proceeds as follows:

The enzyme thrombin cleaves an electrogenic substance from the substratewhich in the present example is phenylenediamine which is oxidized onthe electrodes to phenylenediamine. In a preferred embodiment anauxiliary substance is reduced at the same time as the oxidation of thiscleavage product for example of resazurin to resorufin as a result ofwhich a current intensity can be measured which correlates with theamount of cleavage product. Thus, in the present electrochemicalreaction, resazurin is reduced as an auxiliary substance on the cathodewhereas phenylenediamine is oxidized on the anode. A two-electrodesystem is preferably used for the electrochemical measurement ofthrombin activity in which the potential on the working electrode is, onthe one hand, selected to be high enough that the phenylenediaminereleased from thrombin is oxidized and, on the other hand, low enoughthat no residual group of the tripeptide is reduced. The potentialdifference between the cathode (working electrode) and the anode(counter electrode) is controlled by a potentiostat. In the presentexample a potential difference of about 550 mV can be selected as asuitable potential difference in order to enable only the desiredreactions to occur at the electrodes.

With regard to the method according to the invention thiselectrochemical test principle is used in a factor Xa inhibitor test asfollows:

In the reaction mixture there is, in addition to the detection reagent,a known amount of factor Xa which is formed by adding a known amount offactor X reagent and an activator reagent which converts factor X intofactor Xa. The blood sample to be analyzed contains the factor Xainhibitor to be determined which is preferably a heparin. This inhibitorforms a stoichiometric complex with the factor Xa which is present inthe reaction mixture in a known amount and in excess and antithrombinIII which is present in the blood sample. In this process a residualamount of factor Xa remains, the concentration of which depends on theconcentration of the factor Xa inhibitor in the sample. This can nowreact with the prothrombin present in the blood sample (and with thefactor Va which is also present there) to form a prothrombin complex andsubsequently thrombin which, as described above, can be determined by athrombin-dependent enzymatic cleavage of an electrogenic substance andthe electrochemical detection of the substance.

The more factor Xa inhibitor is present in the sample, the less residualfactor Xa remains after the complex formation with ATIII and the lessthrombin is formed. The present measuring principle does not detect aclotting time in the strict sense i.e. it is not a clotting test withthe formation of fibrin but rather a determination of the time course ofthrombin formation by electrochemical methods.

Example 2 and FIG. 1 show the result of such an electrochemical thrombindetermination according to the inventive methods as an example.

The use according to the invention of activated factor Xa with athrombin detection reagent gives more information about thephysiological state of the coagulation system compared to chromogenicfactor Xa tests and the methods described in WO 01/63271(US2003/0164113) because in this case it is not an artificial factorXa-specific substrate which is cleaved and used to measure the factor Xaactivity but rather firstly thrombin is formed as in the physiologicalcoagulation. This formation of thrombin can according to the inventionbe determined electrochemically using a thrombin-specific substrate andconverted for example into clotting times using a suitable algorithm.Compared to factor Xa inhibitor tests such as the Heptest or the ENOXtest which are based on the determination of the factor Xa-inducedformation of a fibrin clot, the invention has the advantage that thedetermination by means of electrochemical methods is much more simpleand can be carried out less labour-intensively and with simplerequipment. Since the factor Xa activity is determined with the methodaccording to the invention by the activity of the first naturallyoccurring coagulation factor (thrombin) which is downstream thereof inthe physiological coagulation cascade, the physiological activity of thefactor Xa inhibitor is determined, on the one hand, in a manner that iscloser to the natural system than with chromogenic tests and the methodsdescribed in WO 01/63271 (US2003/0164113) which use unphysiologicalfactor Xa substrates and, on the other hand, the detection of the factorXa activity is carried out at an earlier point in the coagulationcascade than is the case with tests that are based on the determinationof the factor Xa-induced formation of a fibrin clot so that thedownstream coagulation factors between thrombin formation and fibrinclot formation have no effect on the determination of factor Xaactivity. This allows more accurate and more specific information to beobtained about factor Xa activities in the physiological system thanwith the previously known tests.

The inventive solution allows a factor Xa inhibitor determinationespecially also in whole blood because, in contrast to chromogenicmeasuring methods, it is not necessary to separate interfering and inparticular coloured blood components in the electrochemical methods thatare used. By matching the control of the electrodes to the electrogenicsubstances used for the detection for example by adapting the selectedelectrode potential, it is possible to detect the electrogenicsubstances used for the detection substantially uninfluenced by otherpotentially interfering substances occurring in the sample or thereagents.

In order to determine a factor Xa inhibitor it is necessary according tothe invention to add at least the following substances to the sample tobe examined or they must be present in the sample: A known amount offactor X, an activator reagent and a peptidic thrombin substrate as thedetection reagent from which an electrogenic substance can beenzymatically cleaved off.

Many of the known thrombin substrates used in thrombin tests includingthe widely used Chromozym TH do not, however, have an absolute andexclusive thrombin specificity but rather can also be cleaved by otherenzymes.

The coagulation factor Xa is a serine protease which naturallyrecognizes the amino sequence—Ile-Glu-Gly-Arg- of prothrombin and bycleaving this sequence, activates the natural substrate prothrombin toform thrombin. In addition to this physiological substrate, factor Xa isalso able to enzymatically cleave other peptides having this or othercleavage sequences. Thus, peptidic thrombin substrates and in particularthe widely used Chromozym TH can also be cleaved by factor Xa. This lowsubstrate specificity of factor Xa can result in problems in the methodsaccording to the invention especially when such a thrombin substratewhich can also be cleaved by factor Xa is used as a detection reagentand already comes into contact with factor Xa before adding the sampleand can be converted thereby. As a result a portion of the thrombinsubstrate can already be converted such that this is no longer availablefor the thrombin-mediated detection reaction and thus the result of themeasurement is affected. Such undesired side reactions can occurespecially when factor Xa and the thrombin substrate are in contact overa long period such as would be for example the case if these twosubstances were to be introduced simultaneously into a liquid detectionreagent.

With regard to the previously mentioned exemplary measuring system thiswould mean that if factor Xa and the reduced Chromozym TH used as athrombin substrate were already able to react with one another over along period before the start of the detection reaction, a portion of thethrombin substrate would already be cleaved and thus a largely undefinedamount of the cleaved electrogenic substance would already be present inthe reagent. Such cases can occur especially when the two substances arepresent together in a liquid reagent or in the case of dry chemistrytests, came into contact in liquid form during their production. Thus, acommon dwelling time of 2 h may already be sufficient to cleave about25% of the reduced Chromozym TH that is present due alone to the actionof factor Xa. The result of such a factor Xa-induced premature substratedegradation would in the case of the electrochemical method according tothe invention be in particular that the measurement signal is offsettowards higher current strengths and also has high current strengths atthe minimum already before the start of the thrombin-induced cleavage ofthe reduced Chromozym TH because phenylenediamine that has already beenreleased in the sample due to the enzymatic action of factor Xa ispresent as an electrogenic substance.

According to the invention the problem of premature factor Xa-inducedsubstrate degradation is at least partially solved in that a knownamount of factor Xa is obtained in the reaction mixture by adding aknown amount of factor X reagent and an activator reagent to the samplewhich results in the conversion of the proteolytically inactive factor Xinto the proteolytically active factor Xa.

Surprisingly this method according to the invention has shown that aparticularly simple and stable test element assembly can be achieved bythis reagent combination. The fact that no activated factor Xa butrather inactive factor X is present in the reagent before adding oractivating an activator reagent, enables the detection reagent to bealready brought into contact with factor X before the start of thedetermination reaction without a premature factor Xa-induced substratedegradation and thus interference with the determination occurring.

In particularly preferred embodiments an activator or a complex involvedin the extrinsic pathway of plasmatic coagulation is used as anactivator reagent. In particular naturally occurring activators orcoagulation factors such as tissue factor and/or factor VIIa can be usedas activator reagents and it is also possible to use other activatorssuch as synthetically produced activators in addition to the naturallyoccurring activators or coagulation factors.

In further preferred embodiments an activator or a complex involved inthe intrinsic pathway of plasmatic coagulation is used as an activatorreagent. In particular naturally occurring activators or coagulationfactors such as factor XIIa or substances which result in a conversionof factor X into factor Xa such as Russels Viper Venom (RVV-X) can beused as activator reagents, and other activators such as syntheticallyprepared activators can also be used in addition to these naturallyoccurring activators.

In this case the activator reagent can be added as an external reagentto the sample or to the other reagents before or during the course ofthe measurement or it can already be present in the blood sample. Thisalso applies similarly to further substances that are necessary for theprocess of factor Xa activation or for the detection reaction. Thus, inparticular further required coagulation factors such as factor V orantithrombin can be provided by the blood sample to be analyzed.

In a particularly preferred embodiment of this variant factor X reagentis added to the sample spatially or chronologically separated from theaddition of the activator reagent to the sample.

The separation of factor X reagent and activator reagent avoids anundesired premature conversion of factor X into factor Xa. This is thebasis for an amount of factor Xa that is known as accurately as possibleat the beginning of the measurement which in turn has a decisiveinfluence on the determination of the factor Xa inhibitor. In this casethe addition of factor Xa reagent to the sample is spatially and/orchronologically separated from the addition of the activator reagent tothe sample.

Dry chemistry reagents are usually applied to test elements by applyingthem as a solution in a line-shape on the test element and removing thesolvent there so that they are present there in a dry chemistry form.This is particularly advantageous since reagents in a dry chemistry formoften meet substantially higher requirements with regard to shelflifeand stability than wet chemistry reagents. Transfer into the more activebut also more unstable dissolved form occurs at a given time byredissolving the dry chemistry reagents by supplying liquid andpreferably by directly dissolving them in the blood sample to beanalyzed.

The ability to arrange different reagents in different compartments on atest element substantially prevents contact between these reagents untilthe start of the factor Xa inhibitor determination. This also allowsundesired side reactions of these reagents to be largely suppressed. Thereagents present in the various compartments are preferably only broughtinto contact with another by the sample liquid. In wet chemistry methodsthis can for example be achieved in that the reagent solutions arepresent in different liquid spaces and only come into contact with thesample at the start of the factor Xa inhibitor determination for examplein that they are added from these spaces to the sample by means of apump or in that sample flows successively through the different liquidspaces.

Preferred methods and devices which result in a spatially orchronologically separated addition of activator reagent and factor Xareagent to the sample can in particular be configured in the form ofseparate reagent lines.

In order to determine factor Xa inhibitors according to the invention adetection reagent must also be present in addition to the factor Xreagent and the activator reagent. These reagents can be present beforethe start of the determination in at least partially spatially separatedcompartments. Since according to the present invention no factor Xashould be present before the start of the detection reaction, it is alsopossible in preferred embodiments that the factor X reagent or theactivator reagent is present together with the detection reagent. Thisalso applies similarly in the case of wet chemistry methods to thebringing together and mixing of reagents. Thus in this case the factor Xreagent or the activator reagent can be present together with thedetection reagent in a reagent solution. Factor Xa is not formed untilthe missing reagent component (factor X reagent or activator reagent)has been added to this reagent mixture.

These reagent mixtures make methods of determination and devicespossible which require fewer process steps or reagent compartments andare thus easier and more cost-effective to manufacture and easier tohandle.

In a particularly preferred embodiment the factor X reagent is acomponent of the detection reagent and the addition of this detectionreagent/factor X reagent combination to the sample is spatially orchronologically separated from the addition of the activator reagent tothe sample.

Preferred methods and devices which allow the activator reagent anddetection reagent/factor X reagent combination to be added to the samplein a spatially separated manner or at separate times can be designedsimilarly to the previously described methods and devices which allowactivator reagent and factor X reagent to be added to the sample in aspatially separated manner or at different times, in particular in theform of separate reagent lines.

In particular the detection reagent/factor X reagent combination can beadded after the addition of the activator reagent. In a preferredembodiment the reagents are spatially separated by arranging reagentlines consecutively in the flow direction of the sample and thus theirreagents are successively activated by the sample which corresponds to astaggered addition to the sample. In this case the reagent lines can bepresent separated from one another or can also be in contact with oneanother, for example be adjacent to one another or also be entirelyapplied on top of one another or partially staggered. In a particularlypreferred embodiment the reagent line of the activator reagent is atleast partially applied in front of the reagent line of the detectionreagent/factor X reagent combination in the flow direction of the samplepreferably in the form of partially overlapping reagent lines or reagentlines lying above one another where in the latter case the reagent lineof the activator reagent is applied over the reagent line of thedetection reagent/factor X reagent combination.

Example 3 and FIG. 2 show examples of electrochemical thrombindeterminations with different arrangements of reagent lines of theactivator reagent and the detection reagent/factor X reagent combinationon a test element.

In a further preferred embodiment of this variant the factor X reagentis added to the sample in a common step with the addition of theactivator reagent to the sample.

In the case of wet chemistry reactions this can for example be carriedout by jointly adding both reagents to the sample from their respectivestorage compartments (storage containers) for example by means of pumpsor pipettes. It is, however, also possible that the factor X reagent andactivator reagent are firstly added to one another and this reagentmixture in which factor Xa forms is then added to the sample.

In a particularly preferred embodiment the factor X reagent andactivator reagent are both present in a dry state and factor X is onlyconverted into factor Xa by contact with the sample.

The use of dry chemistry reagents enables them to be stored together inan inactivated form without a chemical reaction taking place between thereagents. The reagents are not converted into a state in which they canreact with one another until the dry chemistry reagents are wetted. This“activation” of the dry chemistry reagents is affected by the liquidblood sample itself in a preferred embodiment.

In a particularly preferred embodiment factor X reagent, activatorreagent and detection reagent are present as dry chemistry reagents andfactor X is not converted into factor Xa until contact with the sample.

Since the use of dry chemistry reagents allows them to be storedtogether in an inactivated form without a chemical reaction occurringbetween the reagents, these methods and devices according to theinvention allow all reagents necessary for determining factor Xainhibitors to be stored in a common compartment without a prematurefactor Xa-induced thrombin substrate degradation occurring. Only whenthe liquid sample is added, is factor X converted into factor Xa with asubstantially defined starting point and time course so that finally aknown amount of factor Xa is present in the sample which forms the basisfor determining factor Xa inhibitors according to the principle of theinvention. This basically allows all reagents necessary to determinefactor Xa inhibitors to be combined in a single dry chemistry reagentline or spot using methods known to a person skilled in the art whichenables a simple and cost-effective production and a simple and lesserror-prone handling.

The methods and devices according to the invention for determiningfactor Xa inhibitors can be used especially advantageously to determineheparins and in particular fractionated or low-molecular-weightheparins. Other factor Xa inhibitors that can be advantageouslydetermined using the methods and devices according to the invention canbe in particular indirect selective or direct factor Xa inhibitors.

Factor Xa inhibitors in the sense of the invention can be regarded asall substances which directly or indirectly influence the activity offactor Xa and in particular reduce the activity and thus have aninfluence on and in particular retard the blood coagulation cascadeprocess. Direct factor Xa inhibitors have a direct effect on factor Xaand thus influence its activity whereas indirect factor Xa inhibitors donot directly interact with factor Xa but rather have an effect on itsquantity and formation or require a cofactor for their activation. Theymay for example be anticoagulants which act on coagulation factors whichare present in the coagulation cascade before factor Xa and are involvedin its formation and/or regulation. Examples of indirect selectivefactor Xa inhibitors are certain pentasaccharides such as Fondaparinuxand Idraparinux which act in cooperation with antithrombin III and, incontrast to the heparins, are selective for factor Xa. Examples ofdirect Xa inhibitors are Otamixaban or Razaxaban.

Another aspect of the present invention concerns test elements with anelectrochemical sensor on a dry chemistry basis for determining factorXa inhibitors, in particular unfractionated heparins, fractionated orlow-molecular-weight heparins, indirect selective factor Xa inhibitorsor direct factor Xa inhibitors, which, on an inert carrier, has at leasttwo electrodes and a detection reagent which contains at least onethrombin substrate which consists of a peptide residue that can becleaved by thrombin and is bound amidically via the carboxyl end to anelectrogenic substance, as well as at least a certain amount of factor Xreagent and an activator reagent.

Such test elements according to the invention are particularly suitablefor carrying out the previously described methods according to theinvention for determining factor Xa inhibitors in blood samples.

Test elements according to the invention are in particularelectrochemical test elements on a dry chemistry basis. Such testelements contain at least two electrodes of which at least one electrodeis a so-called working electrode. They do not necessarily contain aclassical reference electrode such as for example an Ag/AgCl referenceelectrode but rather merely at least one working electrode and onecounter electrode. The electrodes can be constructed from all currentelectrode materials such as metals, noble metals, alloys or graphite andpreferably from noble metals such as gold or palladium, or graphite. Thedifferent electrodes of the test element can consist of the same ordifferent materials. In a particularly preferred embodiment the testelement contains a working electrode and a counter electrode which bothconsist of gold.

Specific embodiments of such electrochemical test elements especiallywith regard to the choice of materials, arrangement of electrodes andreagents as well as the manufacture of test elements are described inthe prior art for example in U.S. Pat. Nos. 5,762,770, 6,270,637 or WO01/63271 (US2003/0164113) and are known to a person skilled in the art.

In preferred embodiments the reagents are applied to the electrodes inthe form of one or more reagent lines. These can be present separatefrom one another or partially or completely overlap. Furthermore,according to the invention it is possible to apply and dry the reagentsnot directly on the electrodes but rather in the vicinity of theelectrodes for example on a flat substrate next to the electrodes. Inthis case the reagents are transported with the sample to the electrodesduring the measurement. Alternatively the reagents can be accommodatedin porous materials such as for example fleeces, papers, membranes andsuch like which can for example be impregnated with them in a detachablemanner. In this case the sample must flow through these materials duringwhich the reagents can be released into the sample before contact withthe electrodes. It is also possible to apply individual components ofthe reagents onto different compartments of the test element, forexample the detection reagent on or directly next to the electrode, buta factor X reagent and an activator reagent spatially separatedtherefrom (e.g. further removed from the electrode) or to impregnatethem in different layers (e.g. membranes or fleeces).

According to the invention the test element contains factor X reagentand an activator reagent which converts factor X into factor Xa wherethe activator reagent is present on the test element at least partiallyspatially separated from the factor X reagent and in particular isarranged at least partially in front of the factor X reagent in the flowdirection of the sample.

In a preferred embodiment this is for example achieved in that thefactor X reagent and activator reagent are arranged on the test elementin the form of separate reagent lines. These can be present separatedfrom one another or be in contact with one another. An arrangement isparticularly preferred in which the reagent line of the activatorreagent is arranged at least partially in front of the reagent line ofthe factor X reagent in the flow direction of the sample and is at leastpartially in contact with this line and in particular at least partiallyoverlaps this line. In this embodiment the detection reagent is presentin a further compartment and in particular in a further reagent linewhich can, however, at least partially be in contact with the reagentlines of the activator reagent and of the factor X reagent.

In a particularly preferred embodiment the detection reagent is presenton the test element together with the activator reagent or the factor Xreagent. Since neither the activator reagent nor factor X reagent haveactivated factor Xa or can alone form factor Xa, the detection reagentcan be admixed with one of these reagents without a premature factorXa-induced degradation of the detection reagent occurring and thuswithout an undesired interference of the factor Xa inhibitordetermination. The addition of the detection reagent to one of the twoother reagents allows one reagent compartment to be dispensed with,which enables simpler test element constructions that can bemanufactured more cost-effectively. In a particularly preferredembodiment this can for example be achieved by an arrangement in whichthe reagent line of the activator reagent is arranged at least partiallyin front of the reagent line of the factor X reagent in the flowdirection of the sample and is at least partially in contact with thisline and in particular at least partially overlaps this line and thedetection reagent is present in a reagent line together with the factorX reagent.

In a further embodiment the test element contains the factor X reagentand activator reagent in a dry chemistry form which causes theconversion of factor X into factor Xa where the activator reagent ispresent on the test element together with the factor X reagent andoptionally also together with the detection reagent and where theconversion of factor X into factor Xa does not take place until contactwith the sample. Since the factor X reagent and activator reagent arepresent on the test element in a dry chemistry form, they are present ina form in which they cannot react with one another. Thus the factor Xreagent and activator reagent can be stored together in one compartmentwithout formation of factor Xa. The two reagents cannot react with oneanother until liquid is added and in particular until contact with thesample liquid and factor X can then be converted into factor Xa.

In a preferred embodiment this is for example achieved by arranging thefactor X reagent and activator reagent together on the test element inthe form of a common reagent line. In this embodiment the detectionreagent can be present in an additional compartment, in particular anadditional reagent line which, however, can be at least partially incontact with the reagent line of the combined activator/factor Xreagent.

In a particularly preferred embodiment the detection reagent can also beadded to the factor X reagent and activator reagent so that all reagentsrequired to determine factor Xa inhibitors can be present in a singlecompartment, in particular in a single reagent line on the test element.As already stated the use of dry chemistry reagents enables the factor Xreagent and activator reagent to be jointly brought together in onecompartment without formation of factor Xa. This now also allows thedetection reagent to be added to this reagent combination becausewithout activated factor Xa also no premature factor Xa-induceddegradation of the detection reagent can take place. In particular theinventive solution enables all reagents required to determine factor Xainhibitors to be applied in a single compartment which enables simplertest element constructions that can be produced more cost-effectively.

Another aspect of the present invention concerns electrochemical testelement analytical systems which contain at least one test elementaccording to the patent claims and an instrument for measuring currentor voltage. The use of such instruments enables the detection of theelectrogenic thrombin substrate cleavage products that are formed duringthe course of the factor Xa inhibitor determination and in particularphenylenediamine by means of the current flow occurring at theelectrodes. In particularly preferred embodiments the time course of thecurrent flow is measured. The electrochemical determination ispreferably carried out quasi-potentiostatically preferably using a twoelectrode system in which one electrode is connected simultaneously as areference and counter electrode and the other electrode is connected asa working electrode. A constant voltage is applied to this two-electrodesystem and the current is measured over time. This method is alsoreferred to as an amperometric measurement procedure. In this procedurethe time course of the current is measured and one determines afterwhich period of time from the start of the determination reaction themeasured current exceeds a predetermined threshold value. This timeperiod is a measure for the factor Xa-induced thrombin substrateconversion during the course of the coagulation reaction which in turndepends on the amount of factor Xa-inhibitor present in the sample.

In addition to the described amperometric measurement procedure it isalso possible to use voltametric measurement procedures. In this casethere is not a controlled constant voltage between the electrodes butrather the voltage is changed linearly from an initial value to an endvalue and subsequently again returned to the initial value. This processcan be repeated several times over the entire period of measurement. Inthe case of voltametric procedures, the current is plotted against thevoltage and one obtains nested current-voltage curves(cyclovoltamograms) corresponding to the number of repetitions. With asuitable voltage range oxidation peaks and reduction peaks of theelectron carrier are displayed in these curves. The height of thesepeaks is directly proportional to the concentration of the electroncarrier provided no other redox-active substances are co-oxidized orco-reduced in the covered potential range and thus do not additionallycontribute to the current. When measuring a change in concentration itmay be possible to disregard such an interference. If one now plots thecurrent values of the peak maxima or the areas enclosed by the curves(corresponding to the charge turnover) of the individual current-voltageloops over time one also obtains a picture of the concentration changeof the electron carrier over the measurement period in a time framegiven by the duration of the cycle. This information can then be usedlike the amperometric methods to determine the factor Xa inhibitor. Suchmethods are described for example in WO 01/63271 (US2003/0164113).

The methods and devices according to the invention can be used inparticular to determine factor Xa inhibitors in blood samples. In thesense of the present invention the term blood sample includes not onlyuntreated blood (whole blood) but also blood derivatives or bloodproducts which can be obtained from native blood samples by subsequentphysical and/or chemical and/or biochemical treatment. Serum or plasmain particular can be regarded as blood derivatives in the sense of thepresent application. The determination of factor Xa inhibitors can inthe sense of the present application be any qualitative, quantitative orsemi-quantitative determination of factor Xa inhibitors.

The following are provided for exemplification purposes only and are notintended to limit the scope of the invention described in broad termsabove. All references cited in this disclosure are incorporated hereinby reference.

EXAMPLES Example 1 Exemplary Configuration of a Test Element Accordingto the Invention

A possible configuration of a test element according to the inventionand its manufacture are described in the following as an example.

The inert carrier material can for example consist of a polyester foilfor example a Melinex foil. Electrode structures can be applied to thisfoil using various methods for example by vapour coating the carrierfoil with gold and subsequent laser ablation of the desired electrodestructures where other methods for producing these electrode structuresare also familiar to a person skilled in the art such as etching methodsor printing methods. Optionally certain parts of the electrodestructures can subsequently be provided with insulating layers.

The reagents required for the determination are now applied to thecarrier material with its electrode structures. Different methods knownto a person skilled in the art can be used for this and in particularprinting or knife coating methods in which the reagents are applied tothe test element in a dissolved form in the form of reagent lines andsubsequently the solvent is at least partially removed so that thereagents are present on the test element in a dry chemistry from i.e.inactivated form. Such methods are described for example in WO 01/63271(US2003/0164113).

In such coating methods the reagents are usually dissolved in a baseformulation which contains substances that enable an optimal processingof the reagent solution.

An exemplary composition of such a base formulation is for example(dissolved in redistilled water):

Function of Concentration * Substance the substance Supplier 3.5 g/lKeltrol F film former Roche Diagnostics (0-50 g/l) GmbH 5 g/lhydroxypropyl thickener Hercules (0-75 g/l) cellulose 1 g/l Mega 8detergent Roche Diagnostics (0-10 g/l) GmbH 20 g/l Mowiol film formerKuraray (0-200 g/l) base buffer 120 mM HEPES pH buffer Sigma (10-500 mM)10 g/l RPLA 4 protective Roche Diagnostics (0.1-100 g/l) (serum albumin)protein GmbH 30 g/l glycine stabilizer, Roche Diagnostics (0-200 g/l)solubilizer GmbH 75 g/l sucrose stabilizer, Roche Diagnostics (0-300g/l) solubilizer GmbH * Number in paranthesis show the range possibleaccording to the invention)

Each of the specific reagent components (e.g. thrombin substrate, factorX, activator reagent; individually or also in combination) are now addedto this base formulation and applied to the test element in a spatiallydefined manner for example as reagent lines or reagent spots. After thesolvent has been removed, defined and stable reagent lines or reagentspots are now present on the test element in which the reagents can bestored in a stable form over a long period without loss of activity. Inpreferred embodiments, lateral spacers and a cover foil are also appliedwhich define a capillary channel through which a substantially definedvolume of sample can be taken up and transported to the reagentcompartments and electrodes.

Example 2 Exemplary Procedure for an Electrochemical Factor Xa InhibitorDetermination Corresponding to the Methods and Devices According to theInvention

In order to carry out a factor Xa inhibitor determination, an adequateamount, for example 1-1000 μl and preferably about 10 μl, of the bloodto be analyzed is applied to a test element according to the inventionthat can for example be manufactured according to example 1, in such amanner that it comes into contact with the reagent compartments andelectrodes located on the test element. This can preferably be achievedby the presence of a capillary channel on the test element and suitablepositioning of the reagent compartments and electrodes on the testelement within this capillary channel. In preferred embodiments thesample liquid, test element and/or other devices necessary for thefactor Xa inhibitor determination can be maintained at a certaintemperature, in particular a temperature of about 37° C. The testelement is connected to a suitable measurement device in order to detectthe electrochemical detection reactions, for example to a currentmeasurement system which can in particular measure and store the timecourse of the current flow.

FIG. 1 shows an example of the time course of an electrochemical factorXa inhibitor determination corresponding to the methods according to theinvention. In this case a test element according to Example 1 was used.

The curve shows the time course of the measured current intensity causedby the oxidation of phenylenediamine after its thrombin-induced cleavagefrom the thrombin substrate. The time t in seconds after applying theblood sample is plotted on the x axis and the current intensity I innanoamperes determined at the respective time point is plotted on the yaxis. The curve firstly passes through a minimum then increases withincreasing oxidation of the phenylenediamine, finally reaches a maximumand then decreases continuously due to substrate depletion. Theevaluation of such current time courses to determine time parameterswhich reflect the course of the detection reaction, is for examplecarried out using a threshold algorithm. This algorithm adds a thresholdvalue to the calculated minimum, for example 60 nA, which is retainedfor all measurements. The time after reaching the minimum up to whichthis threshold value is reached, can be determined as the time parameterfor thrombin conversion. Since the time parameters for thrombinconversion determined in this manner depend on theactivity/concentration of activated factor Xa and this in turn dependson the amount or concentration factor Xa inhibitors that may be present,the time values determined in this manner can thus be used to deduce thepresence of a factor Xa inhibitor, whether it exceeds or falls below acertain concentration or the amount or concentration of a factor Xainhibitor. For this purpose it is for example possible to generatecurves using samples of known factor Xa inhibitor concentrations whichcorrelate these concentrations with their time parameters determinedaccording to the invention.

Furthermore, these time parameters that have been determined can be usedto determine further parameters that correlate therewith and with theamount of factor Xa inhibitor that may be present, in particularclotting times by using suitable algorithms.

Example 3 Effect of the Arrangement of Reagent Lines on the Test Elementwhich Contains the Factor X Reagent and an Activator Reagent

FIG. 2 shows the results of electrochemical thrombin determinations withdifferent arrangements of reagent lines of an activator reagent and of adetection reagent/factor X reagent combination on a test element. Ineach case the time course of the measured current intensity is shownwhere the time t in seconds after applying the blood sample is plottedon the x axis and the current intensity I in nanoamperes determined atthe respective time point is plotted on the y axis. In the presentexample the reagent line of the detection reagent/factor X reagentcombination contains 0.8 ml reduced Chromozym TH and 38.1 μl factor X(factor X from American Diagnostics; corresponding to 2 U/ml factor Xa),the reagent line of the activator reagent contains 80 μl Russels vipervenom (Russels Viper Venom (RVV-X) from Pentapharm Ltd.) and 0.04%phospholipids (PHL).

The reagent lines were applied in the following variants:

Curve A: Firstly the reagent line of the detection reagent/factor Xreagent combination was applied and then the reagent line of theactivator reagent was applied over this line.

Curve B: Firstly the reagent line of the detection reagent/factor Xreagent combination was applied and then the reagent line of theactivator reagent was applied over this line, where the application ofthe reagent line of the activator reagent was staggered so that at leastpart of it was in front of the reagent line of the detectionreagent/factor X reagent combination in the flow direction of the sampleand at least partially overlapped this line.

Both curves in FIG. 2 show no displacement of the minimum towards highercurrent values and a low initial current. This indicates that prematuresubstrate degradation can be largely suppressed with these preferredmethods and devices according to the invention by the at least partialspatial separation of the reagents into two compartments in particularreagent lines.

A displaced application of the reagent line of the activator reagent infront of the reagent line of the detection reagent/factor X reagentcombination in the flow direction of the sample (curve B) exhibits lowercurrent maxima and retarded reaction kinetics compared to theapplication of the reagent line of the activator reagent directly overthe reagent line of the detection reagent/factor X reagent combination(curve A). An application of the reagent line of the activator reagentdirectly over the reagent line of the detection reagent/factor X reagentcombination is particularly advantageous for the inventive determinationof factor Xa inhibitors and in particular for diagnostic applicationsprimarily due to the more rapid reaction kinetics.

Although various specific embodiments of the present invention have beendescribed herein, it is to be understood that the invention is notlimited to those precise embodiments and that various changes ormodifications can be affected therein by one skilled in the art withoutdeparting from the scope and spirit of the invention.

What is claimed is:
 1. A test element for determining an amount of afactor Xa inhibitor, the element comprising an inert carrier comprisingat least two electrodes, a reagent comprising a known amount of factorX, an activator reagent for converting factor X into factor Xa, and adetection reagent that contains at least one peptidic thrombin substratethat can be cleaved by thrombin and comprising a carboxyl end that isamidically bound to an electrogenic substance, wherein the reagentcomprising factor X and the activator reagent are present on the elementas dry chemistry reagents in spatially separated compartments.
 2. Thetest element of claim 1, wherein the Xa inhibitor is selected from thegroup consisting of unfractionated heparin, fractionated heparin,low-molecular-weight heparin, indirect selective factor Xa inhibitors,and direct factor Xa inhibitors.
 3. An electrochemical test elementanalytical system comprising at least one device for measuring currentor voltage, and a test element according to claim
 1. 4. The test elementof claim 1, wherein the compartments are reaction lines.
 5. A testelement for determining an amount of a factor Xa inhibitor, the elementcomprising an inert carrier comprising at least two electrodes, areagent comprising a known amount of factor X, an activator reagent forconverting factor X into factor Xa, and a detection reagent thatcontains at least one peptidic thrombin substrate that can be cleaved bythrombin and comprising a carboxyl end that is amidically bound to anelectrogenic substance, wherein the reagent comprising factor X and theactivator reagent are present on the element as at least partiallyseparated dry chemistry reagents.
 6. The test element of claim 5,wherein the activator reagent is arranged at least partially in front ofthe reagent comprising factor X in a flow direction of the sample.